Division of Adult Education Form A-25 Rev. 06/13 STUDENT REGISTRATION/ RESIDENCE AFFIDAVIT
Adult Education Student I.D. No. Número de identificación escolar del alumno
5.
Majority of my schooling was outside U.S.
Grade Level (grado escolar): Highest year of school Completed: (grado más alto de escolaridad):
1.
-
Yes (sí)
No (no)
Last Name (Apellido)
6. First Name (Nombre)
Middle Name (Segundo nombre)
Address (Domicilio)
City (Ciudad)
GED Certificate High School Diploma Technical Certificate
State (Estado)
) Home Phone
Número de teléfono en casa
(
/ Month (mes)
Day (día)
Some College No Degree AA/AS Degree 4 Yr. College Graduate
Graduate Studies None Other
Zip Code (Código Postal)
) Work Phone
(
(Estado civil): M /C S/S
No (no)
10. No. of dependent
) Cell Phone
Número de teléfono en el trabajo
8. Marital Status:
Education outside the US? (¿Estudió fuera de EU?) Yes (sí)
Date of Birth (Fecha de nacimiento)
(encerrar uno en un círculo):
Número de teléfono de celular
9.
children under 18: (Número de dependientes menores de 18 años):
Annual Income (Circle One): Ingresos anuales (encerrar uno en un círculo):
Gender: Género (masculino o femenino)
/ Year (año)
M
F
2. Circle all that apply to you: (encerrar en un círculo los que correspondan) Apprenticeship Adult Sch. High School Diploma CalWorks Concurrent Enrollment with High Sch. (CE) District Employee GED GI Bill
Fall
Spring
Summer
FOR OFFICE & OFF SITE TEACHER USE ONLY
Para uso de la oficina: Concurrent H.S. Student: (Current Grade) __________
________________________ SECTION NO. FOR CLASS 1
________________________________ 7.
E-Mail Address (Correo electrónico) (
Highest Educational Level
SEMESTER:
-
Low Income Public Assistance Rehabilitation Special Needs or Disabled Unemployment Veteran
Course
________________________________ Teacher
________________________________ Location/Room
________________________________ Days & Times
________________
___________
IF MARRIED, (SI ES CASADO): Is your annual income less than $28,694? (¿Percibe un ingreso anual menor de $28,694 dólares?) Yes (sí) No (no)
11. Labor Force (Circle One):
Employed
Empleado
IF SINGLE, (SI ES SOLTERO): Is your annual income less than $21,257? (¿Percibe un ingreso anual menor de $21,257 dólares?)
Unemployed
Desempleado
____________________________________ SECTION NO. FOR CLASS 2
Unemployed & not seeking work
Desempleado y no busco trabajo
________________________________
Retired
Jubilado
________________________________
Yes (sí)
No (no)
Fuerza laboral (encerrar uno en un círculo):
Fees Paid
Foreign Tuition
Assigned by: ___________________________
Course
Teacher
3. Race (Check all that apply):
12. Native Language (encerrar uno en un círculo)
4. Ethnicity (etnia):
Raza (marcar los que correspondan):
(Idioma natal (encerrar uno en un círculo): Hispanic or Latino
White African American Asian Filipino Pacific Islander American Indian Alaskan
Not Hispanic or Latino
________________________________
Location/Room English Chinese Tagalog Russian
Spanish Hmong Korean Farsi
Vietnamese Cambodian Lao Other
________________________________ Days & Times
________________
AFFIDAVIT-VERIFICATION OF ADULT EDUCATION STUDENT RESIDENCY I declare under the penalty of perjury that I reside at the street address above. I agree to notify the adult school Within two (2) weeks when residency has been changed either within or outside of the State of California. I understand that if I reside outside of the State of California I must pay non-resident tuition. Declaro so pena de perjurio que resido en el domicilio escrito arriba. En caso de haber un cambio de domicilio dentro o fuera del estado de California, estoy de acuerdo en notificar a la escuela de adultos dentro de un período no mayor de dos (2) semanas. Tengo entendido que si resido fuera del estado de California debo pagar colegiatura como no-residente.
X____________________________________________________________ Student Signature (If minor or Concurrent Enrollment student, parent must sign) Firma del alumno (Firma del padre si se trata de un menor o de inscripción simultánea)
I agree to notify the adult school. Within two (2) weeks when residency has been changed either within or outside of the State of. California. I understand that if I ...
discrimination, violence and bloodshed in their home. state. ... Pakistan, namely, Hindus, Sikhs, Buddhists, Jains, Parsis. and Christians who were compelled to seek shelter in India. due to religious persecution or fear of religious persecution.
Loading⦠Page 1. Whoops! There was a problem loading more pages. Retrying... Affidavit Residency.pdf. Affidavit Residency.pdf. Open. Extract. Open with.
That on the 8th of August, the Ministry of Home Affairs,. Government of India, issued a letter to all the Chief. Secretaries of all the State Governments/UT.
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Plumber ...
Sign in. Loading⦠Page 1. Whoops! There was a problem loading more pages. Affidavit Of Non-Chemigation.pdf. Affidavit Of Non-Chemigation.pdf. Open. Extract. Open with. Sign In. Details. Comments. General Info. Type. Dimensions. Size. Duration. Loca
Page 1 of 60. Bohol Profile. Bohol. Basic Facts. Geographic Location Bohol is nestled securely at the heart of the Central. Visayas Region, between southeast of Cebu and southwest. of Leyte. Located centrally in the Philippine Archipelago, specifical
Page 1 of 3. Certificate of Residence. Appendix A. NAME OF STUDENT: Date of Birth: Grade Level: Address: Father's Name: Father's Address: Phone: Email: Mother's Name: Mother's Address: Phone: Email: Please answer the following questions: 1. Are the s
Page. 1. /. 26. Loading⦠Page 1 of 26. Page 1 of 26. Page 2 of 26. Page 2 of 26. Page 3 of 26. Page 3 of 26. Main menu. Displaying DDA Affidavit In Sealing CaSe.pdf. Page 1 of 26.
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. PATRICIA BAUTISTA AFFIDAVIT (1).pdf. PATRICIA BAUTISTA AFFIDAVIT (1).pdf. Open. Extract. Open with. Sign In.
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Affidavit of ...
Hospitality Management Course at âEuropean College of Business Studiesâ. 3. That whatever liquid funds we are showing for the higher studies of our son in ...
costs at 8 & 9 M are being trade, ... Shipping, Government of India, wide his D.O. letter No. ... app. 6 km, and width of 300 m. No dredging will be required in the Gulf of Mannar Marine .... Expert Committee on Infrastructure Development and.
Loading⦠Whoops! There was a problem loading more pages. Whoops! There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. 22 Affidavit of Ingram.pdf. 22 Affidavit
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Affidavit of ...
I, the undersigned, do hereby agree that all contents of my TAP Senior Project Binder are original works constructed wholly by myself using the resources and ...
Ashurst Student Paper 18. Herbert Smith Freehills Negotiation 20. Jackson McDonald First Year Mooting 22. Australia Red Cross International Humanitarian ...
Page 1 of 2. OWNER'S. GUIDE. NV751. MANUEL DU. PROPRIÃTAIRE. NV751. MANUAL DEL. USUARIO. NV751. www.PoweredLiftAway.com 800.798.7398. ®. Page 1 of 2. Page 2 of 2. Affidavit of Real Property for a Manufactured Home.pdf. Affidavit of Real Property fo
I recognize I am solely responsible for: 1) The selection of instructional materials and textbooks;. 2) The time, place, and method of instruction; and.